In This Edition
Literature at a Glance
A guide to this month’s studies
- PE and COPD exacerbations.
- Care bundles and readmission rates.
- Family history and VTE risk.
- Vasopressor choice and mortality in sepsis.
- Vitamin K use in overanticoagulation.
- Appropriate treatment of asymptomatic bacteriuria.
- Guideline adherence in thrombocytopenia.
LARGE-VOLUME THORACENTESES DO NOT INCREASE THE DIAGNOSTIC YIELD OF MALIGNANT PLEURAL EFFUSION
A prospective observational study showed that for all 23 patients with malignant pleural effusions, the cytology was identical for the 50 mL specimen when compared with the large-volume specimen (~890mL). Large specimens also demonstrated the same yield for detecting negative cytology.
Citation: Abouzgheib W, Bartter T, Dagher H, Pratter M, Klump W. A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Chest. 2009;135(4):999-1001.
DURATION OF COLONIZATION WITH MRSA
In an observational study to evaluate the duration of colonization in patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), 48.8% of patients remained colonized at one year (95% CI, 45.8-51.7%) and 21.2% at four years (95% CI, 13.1-31.4%).
Citation: Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009;48(7):910-913.
GENETIC LOCUS ASSOCIATED WITH INCREASED RISK OF STROKE
Analysis of genomewide association data generated from four large cohort studies of incident stroke found a genetic locus on chromosome 12p13 associated with an increased risk of stroke.
Citation: Ikram MA, Seshadri S, Bis JC, et al. Genomewide association studies of stroke. N Engl J Med. 2009;360(17):1718-1728.
MODERATE CHRONIC KIDNEY DISEASE AND PROTEINURIA PRESENCE ARE ASSOCIATED WITH INCREASED RISK FOR STENT THROMBOSIS
This retrospective, single-center analysis showed that patients with moderate chronic kidney disease (eGFR of 15 to 59 mL min(-1) 1.73 m(-2)) and proteinuria (> or equal to 30 mg/dL) were associated with increased risk for stent thrombosis, nonfatal myocardial infarction (MI), and higher all-cause mortality in patients with an acute MI.
Citation: Lambert ND, Sacrinty MT, Ketch TR, et al. Chronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction. Am Heart J. 2009;157(4):688-694.
MODERN CLINICAL PRESENTATION OF INFECTIVE ENDOCARDITIS IS MORE ACUTE THAN DESCRIBED HISTORICALLY
This prospective cohort study of patients with known infectious endocarditis found that the modern presentation tends to be earlier in the disease course and associated with fevers. However, fewer of the other traditional stigmata of infective endocarditis are present. Staphylococcus aureus has become the dominant organism and mortality remains high.
Citation: Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis—Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-473.
ASPIRIN AND CLOPIDROGREL INCREASE RISK OF PERIOPERATIVE INFECTION AFTER CORONARY ARTERY BYPASS GRAFTING
A retrospective cohort study of patients undergoing coronary artery bypass grafting (CABG) compared the risk of perioperative infection in patients on clopidrogrel and aspirin with patients on neither agent. The study found that patients on these medications have a significantly increased risk of perioperative infection.
Citation: Blasco-Colmenares E, Perl TM, Guallar E. Aspirin plus clopidrogrel and risk of infection after coronary artery bypass surgery. Arch Int Med. 2009;169(8):788-796.
SUBJECTIVE ASSESSMENT OF PERIPHERAL PERFUSION IDENTIFIES CRITICALLY ILL PATIENTS WITH MORE SEVERE ORGAN DYSFUNCTION
Prospective observational evaluation shows that physical examination of peripheral perfusion identifies patients with significantly higher odds of worsening organ failure and higher lactate levels following initial resuscitation.
Citation: Lima A, Jansen TC, van Bommel J, Ince C, Bakker J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med. 2009;37(3):934-938.